ArticlePublisher preview available

Combined transarterial chemoembolization and radiofrequency ablation for subphrenic versus nonsubphrenic hepatocellular carcinoma: a propensity score matched study

Authors:
Jun Gon Kim
Jun Gon Kim
Jun Gon Kim
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Sung Ki Cho
Sung Ki Cho
Sung Ki Cho
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Dongho Hyun at Sungkyunkwan University
Dongho Hyun
Sung Wook Shin at Sungkyunkwan University
Sung Wook Shin
Show all 10 authorsHide
Read publisher preview
Download citation
To read the full-text of this research, you can request a copy directly from the authors.

Abstract and Figures

PurposeTo compare therapeutic outcomes of combined transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) treatment for small hepatocellular carcinoma (HCC) in subphrenic versus nonsubphrenic locations by propensity score matching.Methods This retrospective study included 293 patients with single HCC (≤ 3 cm) ineligible for ultrasound-guided RFA who received iodized oil TACE and subsequent RFA between June 2010 and January 2017. The patients were divided into two groups according to the tumor location: subphrenic (n = 99) and nonsubphrenic (n = 194). Subphrenic HCC was defined as a tumor abutting the diaphragm. Local tumor progression (LTP) and overall survival (OS) rates were compared by propensity score matching. Procedure-related complications were also assessed.ResultsMatching yielded 93 matched pairs of patients. In the matched cohorts, cumulative 1-, 3-, and 5-year LTP rates were 5.4%, 12.1%, and 12.1% in the subphrenic group and 1.1%, 7.5%, and 8.6% in the nonsubphrenic group, respectively, with no significant differences (p = 0.278). Corresponding OS rates were 100%, 80.2%, and 71.3% in the subphrenic group and 97.9%, 88.1%, and 75.6% in the nonsubphrenic group, respectively, with no significant differences (p = 0.308). The subphrenic location was not a significant risk factor for LTP and OS in multivariate analysis. There were no significant differences in complication rates between the two groups (p > 0.05).Conclusion The therapeutic outcomes of combined TACE and RFA for small subphrenic HCC were similar to those for nonsubphrenic HCC. The combination therapy seems to be an effective and safe method in treating small subphrenic HCC.Graphic abstract
Figures - available from: Abdominal Radiology
This content is subject to copyright. Terms and conditions apply.
A preview of this full-text is provided by Springer Nature.
Learn more
Content available from Abdominal Radiology
This content is subject to copyright. Terms and conditions apply.
Vol.:(0123456789)
1 3
Abdominal Radiology (2021) 46:5735–5745
https://doi.org/10.1007/s00261-021-03291-6
INTERVENTIONAL RADIOLOGY
Combined transarterial chemoembolization andradiofrequency
ablation forsubphrenic versusnonsubphrenic hepatocellular
carcinoma: apropensity score matched study
JunGonKim1· SungKiCho1 · DonghoHyun1· SungWookShin1· KwangBoPark1· HongSukPark1·
SungWookChoo1· YoungSooDo1· Sook‑YoungWoo2· Sun‑YoungBaek2
Received: 10 August 2021 / Revised: 17 September 2021 / Accepted: 20 September 2021 / Published online: 28 September 2021
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021
Abstract
Purpose To compare therapeutic outcomes of combined transarterial chemoembolization (TACE) and radiofrequency abla-
tion (RFA) treatment for small hepatocellular carcinoma (HCC) in subphrenic versus nonsubphrenic locations by propensity
score matching.
Methods This retrospective study included 293 patients with single HCC (≤ 3cm) ineligible for ultrasound-guided RFA who
received iodized oil TACE and subsequent RFA between June 2010 and January 2017. The patients were divided into two
groups according to the tumor location: subphrenic (n = 99) and nonsubphrenic (n = 194). Subphrenic HCC was defined as a
tumor abutting the diaphragm. Local tumor progression (LTP) and overall survival (OS) rates were compared by propensity
score matching. Procedure-related complications were also assessed.
Results Matching yielded 93 matched pairs of patients. In the matched cohorts, cumulative 1-, 3-, and 5-year LTP rates were
5.4%, 12.1%, and 12.1% in the subphrenic group and 1.1%, 7.5%, and 8.6% in the nonsubphrenic group, respectively, with
no significant differences (p = 0.278). Corresponding OS rates were 100%, 80.2%, and 71.3% in the subphrenic group and
97.9%, 88.1%, and 75.6% in the nonsubphrenic group, respectively, with no significant differences (p = 0.308). The subphrenic
location was not a significant risk factor for LTP and OS in multivariate analysis. There were no significant differences in
complication rates between the two groups (p > 0.05).
Conclusion The therapeutic outcomes of combined TACE and RFA for small subphrenic HCC were similar to those for
nonsubphrenic HCC. The combination therapy seems to be an effective and safe method in treating small subphrenic HCC.
* Sung Ki Cho
chosk@skku.edu
1 Department ofRadiology andCenter forImaging Science,
Samsung Medical Center, Sungkyunkwan University School
ofMedicine, 81 Irwon-Ro, Gangnam-Gu, Seoul06351,
Korea
2 Statistics andData Center, Research Institute forFuture
Medicine, Samsung Medical Center, Seoul, Korea
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... RFA is an effective treatment option for HCC patients with a diameter smaller than 3 cm. Recent studies further showed that RFA in combination with TACE could effectively increase the ablation area of the tumor, thereby improving the feasibility of treating more large HCC tumors (22). The advantages of TACE + RFA for HCC treatment are as follows: (I) TACE prior to RFA can reduce the cooling effect of liver blood flow on RFA-mediated thermal coagulation; (II) TACE can cause tumor ischemia and edema by embolizing hepatic arterial flow, thereby increasing the area of tumor necrosis by subsequent RFA; (III) embolization of the peripheral portal vein around the tumor tissue by TACE can not only reduce the portal vein flow but also reduce the probability of the HCC invasion into the portal vein (23); and (IV) prior TACE treatment also reduces tumor size, an inherent limitation of RFA (24). ...
Transarterial Chemoembolization Combined With Radiofrequency Ablation Versus Hepatectomy for Hepatocellular Carcinoma: A Meta-Analysis
Article
Full-text available
  • Jul 2022
Background Although many studies reported the effectiveness of transarterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) or surgical resection (SR) in the treatment of hepatocellular carcinoma (HCC), the efficacy of these two strategies remains controversial. Therefore, this meta-analysis aimed to evaluate and compare the efficacy of sequential use of TACE plus RFA (TACE + RFA) and SR alone in treating HCC. Methods Relevant studies with unmatched and propensity score-matched patients were identified by comprehensive search of MEDLINE, PubMed, EMBASE, Web of Science, and Cochrane electronic databases. Meta-analysis was conducted using Review Manager (RevMan) software version 5.4.1. Finally, 12 eligible studies were included in this study, including 11 case–control studies and 1 randomized controlled trial. The primary outcome of interest for this study was to compare the 1-, 3-, and 5-year overall survival (OS) and disease-free survival (DFS), major complications, 5-year OS in different tumor diameters between the two treatment strategies, and hospital stay time. Results HCC patients who received TACE + RFA had a lower incidence of complication rates and shorter hospital stay time than those who received SR alone. Among these studies using propensity score-matched cohorts, SR had better 3- and 5-year OS than TACE + RFA, whereas there were no significant differences between TACE + RFA and SR regarding the 1-, 3-, and 5-year DFS. When the tumor diameter is longer than 3 cm, the 5-year OS rate is better when SR is selected. Conclusion There was no significant difference in the short-term survival outcomes between TACE + RFA and SR in HCC patients. Moreover, SR is superior to TACE + RFA in terms of long-term beneficial effects but may result in a higher risk of major complications and a longer hospital stay time.
View
Comparing transarterial chemoembolization alone to combined transarterial chemoembolization and radiofrequency ablation in primary hepatocellular carcinoma treatment
Article
  • Apr 2025
BACKGROUND Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide. Transarterial chemoembolization (TACE) combined with percutaneous radiofrequency ablation (RFA) has emerged as a promising treatment strategy for patients with unresectable HCC. AIM To evaluate the effectiveness and safety of TACE combined with RFA compared to TACE alone in the management of primary HCC. METHODS A comprehensive retrospective analysis was conducted at our institution from January 2020 to January 2024, involving 106 patients diagnosed with intermediate to advanced-stage HCC. Patients were divided into two groups: Those receiving TACE alone (n = 56) and those undergoing combined TACE and RFA therapy (n = 50). Treatment efficacy was assessed based on tumor response rates, serum alpha-fetoprotein (AFP) levels, and survival outcomes. Statistical analyses, including χ 2 tests and Kaplan-Meier survival analysis, were performed to compare the outcomes between the two groups. RESULTS The TACE + RFA group demonstrated significantly higher rates of complete response (15 vs 4, P < 0.01) and partial response (23 vs 15, P = 0.046) compared to the TACE group. Conversely, the TACE group exhibited higher rates of stable disease (25 vs 7, P < 0.01) and progressive disease (12 vs 5, P < 0.01). Serum AFP levels decreased over time in the TACE + RFA group, while they increased in the TACE group. Survival analysis revealed superior survival outcomes in the TACE + RFA group, with higher survival rates and a prolonged median survival time compared to the TACE group. CONCLUSION The combination of RFA with TACE could offer enhanced treatment response and prolonged survival in patients with primary HCC compared to TACE alone. These findings might support the adoption of multimodal therapeutic approaches, emphasizing the importance of personalized treatment strategies in the management of HCC.
View
Effectiveness and safety of sequential transarterial chemoembolization and microwave ablation for subphrenic hepatocellular carcinoma: A comprehensive evaluation
Article
Full-text available
  • Jul 2024
BACKGROUND Subphrenic carcinoma has been identified as a significant risk factor for the thermal ablation of intrahepatic tumors, resulting in a high rate of residual tumor recurrence. Some studies have proposed that combination treatment with transarterial chemoembolization (TACE) followed by radiofrequency ablation is both feasible and safe for tumors in the subphrenic region. However, research specifically examining the therapeutic outcomes of combination therapy using TACE and microwave ablation (TACE-MWA) in subphrenic tumors is lacking. AIM To evaluate the efficacy and safety of TACE-MWA in patients with subphrenic hepatocellular carcinoma (HCC). METHODS Between December 2017 and December 2021, 49 patients diagnosed with HCC ≤ 6 cm, who received TACE-MWA, were included in this retrospective cohort study. These patients were classified into subphrenic and non-subphrenic groups based on the distance between the diaphragm and the tumor margin. The rates of local tumor progression (LTP), progression-free survival (PFS), and overall survival (OS) were compared between the two groups. Complications were evaluated by using a grading system developed by the Society of Interventional Radiology. RESULTS After a median follow-up time of 38 mo, there were no significant differences in LTP between the subphrenic and non-subphrenic groups (27.3% and 22.2% at 5 years, respectively; P = 0.66), PFS (55.5% at 5 years in both groups; P = 0.91), and OS (85.0% and 90.9% in the subphrenic and non-subphrenic groups at 5 years; P = 0.57). However, a significantly higher rate of LTP was observed in subphrenic HCC > 3 cm compared to those ≤ 3 cm (P = 0.085). The dosage of iodized oil [hazard ratio (HR): 1.52; 95% confidence interval (CI): 1.11-2.08; P = 0.009] and multiple tumors (HR: 13.22; 95%CI: 1.62-107.51; P = 0.016) were independent prognostic factors for LTP. There were no significant differences in complication rates between the two groups (P = 0.549). CONCLUSION Combined TACE and MWA was practical and safe for managing subphrenic HCC. The efficacy and safety levels did not vary significantly when tumors outside the subphrenic region were treated.
View
2018 Korean Liver Cancer Association-National Cancer Center Korea Practice Guidelines for the Management of Hepatocellular Carcinoma
Article
Full-text available
  • Jul 2019
Hepatocellular carcinoma (HCC) is the fifth most common cancer globally and the fourth most common cancer in men in Korea, where the prevalence of chronic hepatitis B infection is high in middle-aged and elderly patients. These practice guidelines will provide useful and constructive advice for the clinical management of patients with HCC. A total of 44 experts in hepatology, oncology, surgery, radiology, and radiation oncology in the Korean Liver Cancer Association-National Cancer Center Korea Practice Guideline Revision Committee revised the 2014 Korean guidelines and developed new recommendations that integrate the most up-to-date research findings and expert opinions.
View
Hepatic resection vs percutaneous radiofrequency ablation of hepatocellular carcinoma abutting right diaphragm
Article
Full-text available
  • Mar 2019
Background: It is usually difficult to adequately conduct percutaneous ultrasound-guided radiofrequency (RF) ablation for hepatocellular carcinomas (HCCs) abutting the diaphragm. Our hypothesis was that the subphrenic location of HCC could have an effect on the long-term therapeutic outcomes after hepatic resection and RF ablation. Aim: To compare the long-term therapeutic outcomes of hepatic resection and percutaneous RF ablation for HCCs abutting the diaphragm. Methods: A total of 143 Child-Pugh class A patients who had undergone hepatic resection (n = 80) or percutaneous ultrasound-guided RF ablation (n = 63) for an HCC (≤ 3 cm) abutting the right diaphragm were included. Cumulative local tumor progression (LTP), cumulative intrahepatic distant recurrence (IDR), disease-free survival (DFS), and overall survival (OS) rates were estimated. Prognostic factors for DFS and OS were analyzed. Complications were evaluated. Results: The cumulative IDR rate, DFS rate, and OS rate for the hepatic resection group and RF ablation group at 5 years were "35.9% vs 65.8%", "64.1% vs 18.3%", and "88.4% vs 68.7%", respectively. Hepatic resection was an independent prognostic factor for DFS (P ≤ 0.001; hazard ratio, 0.352; 95%CI: 0.205, 0.605; with RF ablation as the reference category); however, treatment modality was not an independent prognostic factor for OS. The LTP rate was 46.6% at 5 years for the RF ablation group. The major complication rate was not significantly different between the groups (P = 0.630). The rate of occurrence of peritoneal seeding was higher in the RF ablation group (1.3% vs 9.5%, P = 0.044). Conclusion: Although OS was not significantly different between patients who had gone hepatic resection or percutaneous RF ablation for HCCs abutting the diaphragm, DFS was better in the hepatic resection group.
View
All-treatment array of hepatocellular carcinoma from initial diagnosis to death: observation of cumulative treatments
Article
Full-text available
  • Nov 2017
  • J CANCER RES CLIN
Purpose: In clinical practice, most patients with hepatocellular carcinoma require subsequent treatments for remaining, progressing, or recurring tumors. We investigated all-treatment array and outcomes in an HCC cohort from initial diagnosis to death. Methods: We enrolled 1687 consecutive patients with HCC who underwent initial diagnosis and treatment at the National Cancer Center, Korea, from January 2004 to December 2009. Results: In total, 1357 patients (80.4%) showed RPRTs during median 20.4-month follow-up. Initial transplantation resulted in the least rate (32.3%) of RPRTs. Median treatment frequency was 3.0 times (range 1-20) and 382 patients (27.3%) received treatments ≥6 times. The median treatment frequency was different based on four factors (p < 0.05): age, tumor stage, tumor type and initial treatment modality. Patients with Barcelona Clinic Liver Cancer stage 0 received less frequent treatments. As the stage progressed from 0 to B, the median treatment frequency increased. Radiofrequency ablation as initial treatment was associated with the longest median treatment interval at 19.0 weeks, followed by resection at 14.1 weeks. The median treatment interval was significantly shorter as the stage progressed (p < 0.01). TACE was most frequently performed for RPRTs; the median number of subsequent TACE was 3 (range 1-19). Subsequent treatment array was very heterogeneous, and no certain pattern was found. Conclusions: Our findings suggest that the survival outcome of patients with HCC is based on the results of cumulative multiple treatments rather than an initial treatment. It is time to consider prospective studies evaluating sequential treatment array of HCC.
View
Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update
Article
Full-text available
  • Jun 2017
  • HEPATOL INT
There is great geographical variation in the distribution of hepatocellular carcinoma (HCC), with the majority of all cases worldwide found in the Asia-Pacific region, where HCC is one of the leading public health problems. Since the "Toward Revision of the Asian Pacific Association for the Study of the Liver (APASL) HCC Guidelines" meeting held at the 25th annual conference of the APASL in Tokyo, the newest guidelines for the treatment of HCC published by the APASL has been discussed. This latest guidelines recommend evidence-based management of HCC and are considered suitable for universal use in the Asia-Pacific region, which has a diversity of medical environments.
View
CT-guided versus laparoscopic radiofrequency ablation in recurrent small hepatocellular carcinoma against the diaphragmatic dome
Article
Full-text available
  • Mar 2017
Computed tomography-guided radiofrequency ablation (CT-RFA) and laparoscopic RFA (L-RFA) have been used to treat intrahepatic recurrent small hepatocellular carcinoma (HCC) against the diaphragmatic dome. However, the therapeutic safety, efficacy, and hospital fee have never been compared between the two techniques due to scarcity of cases. In this retrospective study, 116 patients were divided into two groups with a total of 151 local recurrent HCC lesions abutting the diaphragm. We compared overall survival (OS), local tumor progression (LTP), postoperative complications, and hospital stay and fee between the two groups. Our findings revealed no significant differences in 5-year OS (36.7% vs. 44.6%, p = 0.4289) or 5-year LTP (73.3% vs. 67.9%, p = 0.8897) between CT-RFA and L-RFA. The overall hospital stay (2.8 days vs. 4.1 days, p < 0.0001) and cost (¥ 19217.6 vs. ¥ 25553.6, p < 0.0001) were significantly lower in the CT-RFA in comparison to that of L-RFA. In addition, we elaborated on the choice of percutaneous puncture paths depending on the locations of the HCC nodules and 11-year experience with CT-RFA. In conclusion, CT-RFA is a relatively easy and economic technique for recurrent small HCC abutting the diaphragm, and both CT-RFA and L-RFA are effective techniques.
View
Computed tomography-guided transpulmonary radiofrequency ablation for hepatocellular carcinoma located in hepatic dome
Article
Full-text available
  • Jan 2006
  • WORLD J GASTROENTERO
AIM: To determine the feasibility of performing computed tomography (CT)-guided transpulmonary radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) located in the hepatic dome. METHODS: A total of seven patients with HCC comprising seven nodules located in the hepatic dome were treated from April 2004 to December 2004. CT-guided transpulmonary RFA was performed using a cool-tip type electrode (Radionics Company) based on a standardized energy protocol. All tumors located in the hepatic dome were not detectable by the usual ultrasound (US) methods. The lesion diameters ranged from 15 to 27 mm. RESULTS: RFA was technically feasible in all the patients. The puncture procedure was performed twice or less and the total average performance time was 40.6 min. Local tumor control was achieved in all the patients. The necrosis diameter ranged from 25 to 35 mm. The mean follow-up period was 9.6 (7-14 mo) mo. There was no local recurrence at the follow-up points. Pneumothorax requiring pleural drainage was the main complication, which was observed in two of the seven patients (28.6%). However, it improved with chest drainage tube, and the tube could be removed within 2-3 d. No other major complications were observed. CONCLUSION: CT-guided puncture is useful for the treatment of tumors located in the hepatic dome which are hardly detectable by US, even though pneumothorax sometimes may occur as a complication. In the cases with adhesion in the pleura for which artificial pleural effusion methods are not appropriate, CT-guided RFA is thus considered to be an alternative treatment for HCC located in the hepatic dome.
View
Updated 10-year outcomes of percutaneous radiofrequency ablation as first-line therapy for single hepatocellular carcinoma
Article
  • Jan 2020
Objectives The purpose of this study was to evaluate the 10-year overall survival and local tumor progression (LTP) of percutaneous radiofrequency ablation (RFA) for single nodular hepatocellular carcinoma (HCC) < 3 cm using a large longitudinal hospital registry and clinical factors associated with overall survival and LTP.MethodsA total of 467 newly diagnosed patients with single nodular HCC < 3 cm who underwent RFA as first-line therapy between January 2008 to December 2016 were analyzed. Overall survival and LTP were estimated using the Kaplan-Meier method. Cox regression and competing risks Cox regression analysis were performed to identify prognostic factors for overall survival and LTP, respectively.ResultsThe 5- and 10-year overall survival rates after RFA were 83.7% and 74.2%, respectively. LTP (hazard ratio (HR), 2.03; 95% confidence interval (CI), 1.19–3.47) was one of the important factors for overall survival after RFA. The 5- and 10-year LTP rates after RFA were 20.4% and 25.1%, respectively. Periportal location (subdistribution HR, 2.29; 95% CI, 1.25–4.21), subphrenic location (2.25, 1.34–3.86), size ≥ 1.5–< 2.0 cm (1.88, 1.05–3.39), and size ≥ 2.0 cm (2.10, 1.14–3.86) were independent factors for LTP.Conclusion Ten-year therapeutic outcomes of percutaneous RFA as first-line therapy were excellent for single HCC < 3 cm. LTP was an important prognostic factor for overall survival after RFA. Periportal and subphrenic location of HCCs and tumor size were predictors for the development of LTP after RFA.Key Points• Updated 10-year survival outcome of percutaneous radiofrequency ablation as first-line therapy for single hepatocellular carcinoma < 3 cm was higher than previously reported.• Local tumor progression was an important prognostic factor for overall survival after percutaneous radiofrequency ablation.• Periportal and subphrenic location of hepatocellular carcinomas and tumor size were predictors for the development of local tumor progression after percutaneous radiofrequency ablation.
View
EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma
Article
  • Apr 2018
  • J HEPATOL
Liver cancer is the fifth most common cancer and the second most frequent cause of cancer-related death globally. Hepatocellular carcinoma represents about 90% of primary liver cancers and constitutes a major global health problem. The following Clinical Practice Guidelines will give up-to-date advice for the clinical management of patients with hepatocellular carcinoma, as well as providing an in-depth review of all the relevant data leading to the conclusions herein.
View
Combined transarterial chemoembolization and radiofrequency ablation for small treatment-naïve hepatocellular carcinoma infeasible for ultrasound-guided radiofrequency ablation: long-term outcomes
Article
  • Oct 2017
Background Ultrasound (US)-guided radiofrequency ablation (RFA) for small hepatocellular carcinoma (HCC) is often infeasible due to unfavorable location and poor conspicuity. Those small HCCs can be treated with combined transarterial chemoembolization (TACE) and RFA. Purpose To evaluate long-term outcomes of combined TACE and RFA for small treatment-naïve HCC infeasible for US-guided RFA. Material and Methods Between February 2009 and January 2014, 69 patients with small (≤3 cm) HCC infeasible for US-guided RFA received TACE and subsequent RFA in one session as a first-line treatment. Local tumor progression (LTP), overall survival (OS), and event-free survival rates were evaluated. Univariate and multivariate analyses were conducted to identify prognostic factors. Results Cumulative rates of LTP were 4.4%, 6.8%, 8.2%, 9.5%, and 9.5% at one, two, three, five, and seven years, respectively. Cumulative one-, two-, three-, five-, and seven-year OS rates were 100%, 95%, 89%, 80%, and 80%, respectively. Cumulative one-, two-, three-, five-, and seven-year event-free survival rates were 81%, 63%, 54%, 31%, and 20%, respectively. No significant prognostic factors for LTP, OS, and event-free survival were identified in univariate analysis. Conclusion Combined TACE and RFA appears to be an effective treatment for small treatment-naïve HCC infeasible for US-guided RFA in terms of LTP and OS.
View
Iodized Oil Transarterial Chemoembolization and Radiofrequency Ablation for Small Periportal Hepatocellular Carcinoma: Comparison with Nonperiportal Hepatocellular Carcinoma
Article
  • Sep 2017
Purpose: This study aims to evaluate the treatment outcomes of iodized oil transarterial chemoembolization (TACE) and subsequent radiofrequency ablation (RFA) for small (≤3 cm) periportal hepatocellular carcinoma (HCC) compared with nonperiportal HCC. Methods: Twenty-three patients [periportal group (PG); mean age, 59.8 years; 22 men, 1 woman] with periportal HCC (in contact with the portal vein >3 mm in diameter) and 279 patients [nonperiportal group (NPG); mean age, 59.1 years; 234 men, 45 women] with nonperiportal HCC were treated between March 2010 and January 2014. All cases were contraindicated for ultrasound-guided RFA or resection. Mean tumor size was 1.2 cm in each group. The baseline characteristics were not different between the groups, except for alpha-fetoprotein level (41.0 ng/dL in NPG vs. 8.8 ng/dL in PG, p = 0.001). Local tumor progression (LTP), disease-free survival (DFS), overall survival (OS), intrasegmental recurrence, and complications were analyzed using the Kaplan-Meier method and Fisher's exact test. Results: TACE and RFA were successfully performed in all patients. Mean follow-up period of PG and NPG was 33.8 and 42.8 months, respectively. LTP (p = 0.701), DFS (p = 0.718), and OS (p = 0.359) were not different between the two groups. Intrasegmental recurrence occurred in two patients (one in each group), and its incidence was not different (p = 0.212). Complications requiring further treatment occurred in 1/23 (4.3%) in PG and 5/279 (1.8%) in NPG. No procedure-related mortality occurred. Conclusions: Iodized oil TACE and subsequent RFA are effective alternative treatments for small periportal HCC (≤3 cm) when percutaneous ultrasound- or CT-guided RFA or resection is not feasible.
View